Basic Information
| Provider Information | |||||||||
| NPI: | 1811489222 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RUBACHA | ||||||||
| FirstName: | MATTHEW | ||||||||
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| NamePrefix: | DR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 51 STRATH AVE | ||||||||
| Address2: | |||||||||
| City: | TORONTO | ||||||||
| State: | ONTARIO | ||||||||
| PostalCode: | M8X1R4 | ||||||||
| CountryCode: | CM | ||||||||
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| Practice Location | |||||||||
| Address1: | 2390 W CONGRESS ST | ||||||||
| Address2: | |||||||||
| City: | LAFAYETTE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 705064205 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3372616000 | ||||||||
| FaxNumber: | 3372616003 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2018 | ||||||||
| LastUpdateDate: | 10/04/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 320166 | LA | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.